a blog of books every doctor should read

Flow

Synopsis

This book tackles the ambitious task of defining happiness, and deciphering how to achieve it. It is the outcome of the author’s research into ‘the positive aspects of human experience’ which are joy, creativity. It is also an exploration of ‘the process of total involvement with life‘ (page xi). The book starts by describing the innumerable obstacles nature has put in the path of the attainment of happiness. It argues that ‘the universe was not designed with the comfort of human beings in mind…’ because ‘…most of it is hostilely empty and cold,… full of booby traps waiting to go off at any moment’ (page 8). It asserts that ‘the universe was not created to answer our needs’; rather, ‘frustration is deeply woven in the fabric of life’ (page 7). The author completes this gloomy picture of nature when he says ‘in each person’s life, the chances of only good things happening are extremely slim’, and ‘sooner or later everyone will have to confront events that contradict his goals’ (page 202).

Building on this dismal prospect, the author, a renowned psychologist, argues that bliss resides inside people’s consciousness and not in external agents. Happiness, he says, depends on ‘inner harmony‘, and not on the ability to control ‘the great forces of the universe’ (page 9). He shows that happy people actively cultivatehappiness; they control and order the contents of their consciousness, and they give favourable interpretations to their life events (pages 2 and 6). Happy people also build defences against disaster by developing character traits such as courage, resilience, perseverance, and transformational coping (page 202). The book asserts that only these and similar strategies enable people to achieve happiness when faced with adversity and stress (pages 192-213).

Umberto Boccioni [Public domain], via Wikimedia CommonsA key theme of the book, reflected in its title, is the importance of engaging in activities which result in ‘flow‘ or ‘optimal experience‘. This ideal state is attained when people stretch their minds or bodies to the limit in what the author calls worthwhile but voluntary ventures; this is when ‘people are so involved in an activity that nothing else seems to matter’ (pages 3 and 4). It says such enjoyable activities are characterised by ‘clear goals, stable rules, and challenges that are well-matched to skills’. The author reviews several of these activities including reading, competitive activities, games, walking, dancing, eating, sex, hunting, fishing, and developing cognitive skills. He also discusses the eight components of enjoyable experiences which facilitate the attainment of flow; this is essential reading (pages 49-70).

A key insight the book provides is the observation that work is an inherently pleasurable activity. The author cites studies which report that work is the most enjoyable part of people’s lives, even if people would prefer to have more time for leisure-the paradox of work (page 145 and 159-162). He says happy people make work enjoyable by transforming it into a complex activity, and focusing on developing their skills (page 151). The book illustrated this with surgeons who are happiest when their work offers them variety and allows them to experiment with new techniques (page 155). The author suggests that ‘jobs should be redesigned so that they resemble, as closely as possible, flow activities’, and workers should be trained to hone their skills and to set attainable goals (page 157).

The author discussed the important role of familial and genetic factors on the chances of attaining happiness. He, for example, explored the five family characteristics which promote optimal experience, saying that children have a better chance of happiness if they grow up in a family that facilitates clarity of goals, feedback, feeling of control, concentration on the task at hand, intrinsic motivation, and challenges (pages 84-93). The book also reviewed the social factors which reduce the chances of becoming happy. It was particularly scathing of the emphasis many communities wrongly place on wealth, status, power, and comfort; he labels these the ‘projected symbols of happiness’ (pages 44 to 45). Related to this, the author discusses other concepts including the ‘paradox of rising expectations‘ and ‘cultural hubris’ (pages 10-11).

One of the major themes of the book is the role creativity plays in attaining happiness. The author illustrated this with several historical innovative personalities such as Nicolaus Copernicus, Galileo, Isaac Newton, Antoine Lavoisier, Luigi Galvani, and Gregor Mendel. He also cited more recent achievers such as K. Alex Muller and J. Georg Bednorz, pioneers in the field of superconductivity (page 136); and Subrahmanyan Chandrasekhar, the astrophysicist (page 135). The author said it is people such as these, dedicated to playing with ideas, who find breakthroughs (page 136). He reviews the common characteristics of ‘the people of flow‘ making reference to the work of Richard Logan (pages 90-93).

The book is replete with recommendations for achieving happiness. These include delaying gratification, controlling instinctual drives, and finding rewards in ‘the events of the moment‘ (pages 16-19. The author shows how routine activities may be made purposeful and enjoyable, claiming that almost everyone can ‘transform ordinary experience into flow’ by developing skills that stretch their capacities (pages 40, 83, and 213). He advocates the enjoyment of every bodily activity because ‘everything the body can do is potentially enjoyable’ (pages 43 and 95).

Opinion

The book meaningfully addresses the ancient challenge of how to attain happiness. It is a collection of personal observation and research, rather than random philosophical musings. The author explores the subject clearly and comprehensively, successfully establishing a standard definition of happiness, and listing the factors that determine it. Furthermore, the book offers practical tips on achieving this almost elusive objective, and it does justice to a very difficult subject. Whilst the author’s occasional use of hypothetical examples do not sufficiently illustrate his arguments, the historical anecdotes he provides appropriately compensate for these lapses.

Overall assessment

The subject of happiness is slightly obscure even though this is what health care is really about. This book introduces some objectivity to a relatively subjective topic, and it provides lessons that are relevant to patients and their care providers. The author covers this critical subject thoroughly, and I strongly recommend his book to all doctors.